胸腹腔镜下经口腔置入吻合器底钉座的食管癌根治手术的疗效观察

Efficacy of placing stapler anvil bottom through oral cavity under the thoracic laparoscopy for esophageal cancer

摘要:

目的：探讨胸腹腔镜下经口腔置入吻合器底钉座的食管癌根治手术的临床疗效和预后情况。方法：选取我科2008年1月至2013年1月进行手术治疗的食管癌患者共100例，随机分为实验组和对照组。实验组予以经口置入钉砧头系统（OrVil）胸腹腔镜食管癌切除胃食管胸腔内吻合术，对照组予以传统开放手术。对比两组患者的手术及术后一般情况、淋巴结清扫情况、术后短期并发症发生率和术后1年随访情况。结果：实验组的手术时间、术中出血量、术后第1天引流量、术后引流管留置时间和术后住院时间明显低于对照组（P<0.01）。2组患者的清扫淋巴结总数、清扫淋巴结组数、胸腔及腹腔淋巴结清扫数无明显差异，P >0.05。实验组术后短期并发症发生率明显低于对照组（P<0.05）。实验组术后的复发或转移率、死亡率、吻合口狭窄和反流发生率和对照组无统计学差异（P >0.05）。结论：胸腹腔镜下经口腔置入吻合器底钉座手术风险较小，术后并发症发生率低，同时和传统开胸手术相比，根治食管癌能力无明显差异，值得临床应用。

Abstract:

Objective：To investigate the clinical efficacy and prognosis of placing stapler anvil bottom through oral cavity under the thoracic laparoscopy in the treatment of esophageal cancer. Methods：Totally 100 patients with esophageal cancer in our department from January 2008 to January 2013 for surgical treatment were randomly divided into experimental and control group. The experimental group received oral anvil head system（OrVil） chest laparoscopic esophagectomy intrathoracic esophagogastric anastomosis. The con－trol group received traditional thoracotomy. The intra-operation and post-operation condition，lymph node dissection，postoperative complication rate and one-year follow-up were compared. Results：The operative time，blood loss，drainage on the first postoperative day，drainage tube indwelling time and postoperative hospital stay were significantly lower in experiment group than in control group（P<0.01）. There was no difference in the total number dissected lymph node，number of dissected lymph node group，and number of dissected thoracic and abdominal lymph node，P >0.05）. The short-term complication rate of experimental group was significantly lower than that of control group（P<0.05. There was no difference in postoperative recurrence or metastasis rate，death rate，anastomotic stenosis and regurgitation incidences between the two groups（P >0.05）. Conclusion：With fewer risk，lower complication rate and sim－ilar efficacy as traditional thoracotomy，placing stapler anvil bottom through oral cavity under the thoracic laparoscopy is worthy of clinical application